Provider Demographics
NPI:1023083227
Name:COMMUNITY HEALTH IMPROVEMENT CENTER
Entity type:Organization
Organization Name:COMMUNITY HEALTH IMPROVEMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-877-6111
Mailing Address - Street 1:2905 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-877-9117
Mailing Address - Fax:217-877-3077
Practice Address - Street 1:1002 SOUTH RACE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4449
Practice Address - Country:US
Practice Address - Phone:217-239-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH IMPROVEMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-21
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL=========003Medicaid